working with difficult moments: behaviorally speaking

Working with Difficult Moments:

Behaviorally SpeakingJacqueline A-Tjak & Kelly Koerner

with a big thank you to Matthieu Villatte

Aim of this workshop

• Increase your sensitivity for non-verbal signals from your client• Experience the power of validation• Understand validation as a behavioral intervention• Understand difficult emotion (functional analysis)• Work with difficult emotion: informal exposure and emotion

regulation

Difficult moments can arise• When people have histories of continuous unpredictable responses to

their behavior (unsafe attachment, invalidating environments), they are easily overwhelmed by their emotions. The slightest signs of rejection or faults can function as signs of threat

• They can only regulate their emotions by drastic, toxic control efforts• To learn new ways of relating to their emotions they need a

predictable and controllable environment.

Prediction

&

Control

Setting up a context of prediction and control • A therapist who is sensitive to emotions and needs, that cannot be

expressed openly and fully (other-as-process)• A therapist who is willing to take responsibility for emotional

disregulation of the client (willingness and committed action)• A therapist who is transparent about her own feelings,thoughts and

needs (self-as-process)• A therapist who asks for permission

Setting up a context of prediction and control • A therapist who is accepting, defused, present, committed• A therapist who validates the perspective of the client

What’s hard for me right now…

Mindfulnesspurposeful attention

without judgment to the present moment

What is happening right now?

Can I be with this?

whiff of not enough

mental anguish

when what we touch, see, hear, contact

habits of:aversion/craving

fix it so feel better

gives rise to pain

Outside skin

Inside skin

give rise to suffering

habits of:aversion/craving

fix it so feel better“movie of me”

Outside skin

Inside skin

During difficult moments…

What is happening right now?

Can I be with this?

C

T

T attends to patterns of regulating threat and their unintended consequences,

focusing on acceptance

Radiating warmth, ‘we just find ourselves here,

it’s not your fault” stance

As C becomes more flexible again, T attends to assessing and moving toward change

C

T

Validation behaviorally speaking• To affirm the coherence of the story (network) of the other person• = other-as-context: seeing the perspective of the cliënt• = acceptance: accepting the perspective of the cliënt as valid• = defusion from your own story as ‘more true’.• = defusion from being right• Creates a context to open up to new information

I. The bigger picture: shedding new light• NOW, we add new information to the network:• = function: how does it work, short term-long term• = asking for the history: have you had that thought before?• = disconfirming experiences in the past• = metaphor• = socratic dialogue

II. Labeling• Calling a spade a spade• = naming, categorizing: this is fear, this is a thought• = creating a hierarchical relationship between this emotion and all

emotions• Calling your own spade a spade• = modelling• = creating a safe, accepting, defused context• = creating other/self-as-context

III. Alternative reaction• Bringing attention to the bodily felt sensation (from fusion with there-

and-then to here-and-now)• Asking questions about alternatives, for instance valued behavior:

what could you do while you have this thought or emotion?

IV. Harvesting• Is there a difference between how you felt before and after our

discussion? (help noticing that a transformation of stimulusfunctions took place)

More controlSelf acceptance

Overwhelming emotion

ValidationNew Light

First exercise• Have a therapist-client interaction• Client tells about a disturbing experience• Therapist tries to make the client see, that the client is seeing this the

wrong way• Observer: notice the non-verbal behavior of both client and therapist:

tone, volume, posture, pace, facial expression, gestures, tension.

Second exercise• Have a therapist-client interaction• Client tells about a disturbing experience• Observer: notice the non-verbal behavior• Therapist starts with validation• = It is logical that• = I understand that you• = If I were you, I would also ….• = It is as if ….. (metaphor)

AND• When clients opens up, therapist moves into ‘the bigger picture’,

‘labeling’, or ‘alternative reaction’• How could you know that it was the right time to move on to ‘adding

new information’?

Third exercise• Have a therapist-client interaction• Client tells about a disturbing experience• Therapist starts with validation• Now, therapist moves into ‘the bigger picture’, ‘labeling’, or

‘alternative reaction’• Lastly, the therapist harvests• Observer: notice the non-verbal behavior• How could you know that it was the right time to move on to

harvesting?

Informal Exposure

1. Validation evokes other emotions (emotions re-organize us)

2. Block/discourage experiential avoidance and maladaptive emotion regulation in-session

With invalidation, we learn…

Monitoring…attending…CHANGE

Emotion fires

Disrupts naturally organizing effect of emotion and information from

emotion

Expression elicits other’s

Discomfort, withdrawal,

attack, incomprehension

etc., etc., etc.

whiff of not enough

mental anguish

when what we touch, see, hear, contact

habits of:aversion/craving

fix it so feel better

gives rise to pain

Outside skin

Inside skin

give rise to suffering

Over time, we learn…

Monitoring…attending…CHANGE

Emotion fires

Anxious anticipation of

invalidation

Interrupt self and/or self-invalidate experience or expression (e.g., blunt,

postpone, mute, mask, avoid, numb, secondary emotion,

etc.)

Disrupts naturally organizing effect of emotion and information from emotion

Secondary Emotion fires

Chain Analysis (aka functional analysis)

Vulnerability factors Precipitating

Event(s)

Consequences

shame1. anger

emotions

vulnerabilitysadnessfear

2. self-contempt

“I” as contact with sensations from a particular location

You (or me) in a context

Sad

overwhelmed

calm

Disappointed

irritated

disturbed

relieved

New cue…voila! Changed organism

Shame

fear

ANGRYdisturbed

sad

New cue…voila! Changed organism

Shame

fear

Self-contempt despair

sad

mad

sad

“this isn’t helping…

Blends of emotions may fire and muddle the naturally adaptive action urges. Validate to establish new stimulus control.

• In context of overwhelmed vulnerability• Sadness, fear, shame, habitual response to threat

Practice: Validate to Differentiate Emotion

“This isn’t helping”Self-contempt/collapse

“This isn’t helping”Attack

Set up

• C: This isn’t helping (with either self-contempt or attack T)

• T: VIVIDLY validate fear, validate anger, validate sadness, whatever emotion is primary and adaptive. Watch to see what natural adaptive action urges arise

Example phrasing

Clients—any effective lines your therapists have said?

Gently block avoidance(CRB1) to shape flexibility (CRB2)

• Cue is sensation of overwhelm/vulnerability• Present cue• Gently block avoidance• Increase inhibitory learning (i.e., help client build new meaning

about the cue, learn cue can be tolerated, worked with, habitual avoidance isn’t needed)

Informal exposureUpgrades(1)____ T EXPLICITLY EXPOSES C TO EMOTION CUES in session (e.g., imaginal exposure, engaging in behaviors known to elicit unjustified emotions, role-play, eliciting new behavior, opposite action) (2)____ T BLOCKS ACTION TENDENCIES associated with C's problem emotions.a>___ T prevents C from engaging in emotional avoidance.b>___ T blocks C's tendency to escape/avoid when feeling afraid.c>___ T blocks C's tendency to hide or withdraw when feeling shame.d>___ T blocks C's tendency to repair or self-punish when feeling unjustified guilt.e>___ T blocks C's tendency to hostile and aggressive responses; f>___ T blocks active-passivity.(4)____ T ENHANCES C's SENSE OF CONTROL over adverse emotional situations.a>___ T designs exposure treatment collaboratively with C.b>___ T instructs C at that he/she has ultimate control over stimuli and can end exposure at any time.c>___ T gets C to collaborate in staying in emotional stimulus condition as long as possible.d>___ T helps C leave or escape situations voluntarily instead of automatically.

Example phrasing

• ‘So let me ask: As I acknowledge how overwhelming this is… What happens when I say that?’

• Uh huh, you notice… and you want to jump to ... So let’s together linger here for a moment. The reason is, I’m thinking you avoid being in this place, and you avoid it so consistently, and as a result it’s like it becomes intolerable when you feel overwhelmed– and we know how that leads to problems for you – so let’s slow down and practice just being here for a few moments. So if I really was disappointed, what would you feel? What do you notice? What goes through your mind? Etc.”

• T begins session as usually do• C: as you bring up first topic, you feel overwhelmed and begin

avoiding (free form)

• T: help C by blocking avoidance, increase learning in presence of cue

Practice: Gently block CRB1 to shape CRB2